Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege (CHU ULiege), Liege, Belgium.
Department of Hepatogastroenterology, CHU Liege, University of Liege (CHU ULiege), Liege, Belgium.
Acta Chir Belg. 2024 Jun;124(3):229-233. doi: 10.1080/00015458.2023.2234724. Epub 2023 Jul 23.
Hepatocellular carcinoma (HCC) found in a non cirrhotic liver represents a minority of HCC cases and remains poorly studied. Due to its specific characteristics and evolution, this tumour requires a different management compared to HCC in a cirrhotic liver.
The authors describe the case of a 68-year-old man diagnosed with a large giant and only mildly symptomatic HCC in a non-cirrhotic liver. The 23 cm HCC was discovered when a thoracoabdominal computed tomography was performed following mild abdominal pain. After a multidisciplinary discussion the tumour was judged to be borderline, but potentially resectable after neoadjuvant therapy and preparation for surgery. The patient underwent selective internal radiation therapy radioembolization of the right hepatic artery lobe with 5,5 GBq of 90Y-labeled glass microspheres. It was followed by extended right hepatectomy after preparation by embolization of the right portal and the right hepatic veins. Thirty months after surgical resection the patient showed neither clinical, radiological nor biological signs of HCC recurrence.
HCC in non-cirrhotic liver is less common than in cirrhotic liver but has a better prognosis, thanks to a greater opportunity for surgical resection. The symptoms often emerge late and are unspecific, thus delaying the HCC diagnosis. Advances in surgical resection by laparotomy or laparoscopy, and neoadjuvant therapy in preparation for surgery, have proven to be effective. However, high mortality persists due to late diagnosis linked to the inability of identifying groups at risk of HCC in the non-cirrhotic population and inadequate screening.
非肝硬化肝脏中发现的肝细胞癌 (HCC) 占 HCC 病例的少数，研究甚少。由于其特殊的特征和演变，与肝硬化肝脏中的 HCC 相比，该肿瘤需要不同的管理。
作者描述了一位 68 岁男性的病例，该患者在非肝硬化肝脏中被诊断出患有大型巨型且仅轻度症状的 HCC。23 厘米的 HCC 是在因轻度腹痛进行胸腹 CT 检查时发现的。经过多学科讨论，该肿瘤被认为是边界性的，但在新辅助治疗和手术准备后可能是可切除的。患者接受了选择性内放射治疗，即右肝动脉叶内的放射性栓塞治疗，使用 5.5GBq 的 90Y 标记玻璃微球。在右门静脉和右肝静脉栓塞准备后，进行了扩大的右肝切除术。手术后 30 个月，患者既没有 HCC 复发的临床、放射学或生物学迹象。
非肝硬化肝脏中的 HCC 比肝硬化肝脏中的 HCC 少见，但由于有更多的手术切除机会，预后较好。症状通常出现较晚且不特异，因此会延迟 HCC 的诊断。通过剖腹手术或腹腔镜手术进行的手术切除的进步，以及新辅助治疗为手术做准备，已被证明是有效的。然而，由于无法识别非肝硬化人群中 HCC 高危人群以及筛查不足导致的晚期诊断，高死亡率仍然存在。
